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Clinical and Experimental Nephrology
Published in: Clinical and Experimental Nephrology 3/2010

01-06-2010 | Original Article

Sirolimus-based calcineurin inhibitor withdrawal immunosuppressive regimen in kidney transplantation: a single center experience

Authors: Sameer M. Alarrayed, Amgad E. El-Agroudy, Ahmad S. Alarrayed, Sumaya M. Al Ghareeb, Taysir S. Garadah, Salah Y. El-Sharqawi, Ali H. Al-Aradi, Balaji G. Dandi, Sadiq Abdulla

Published in: Clinical and Experimental Nephrology | Issue 3/2010

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Abstract

Background/aim

This observational study was conducted to evaluate the safety and efficacy of the conversion from calcineurin inhibitors (CNIs) to sirolimus (SRL)-based immunosuppressive therapy in kidney transplantation.

Materials and methods

Sixty-four kidney recipients of mean age 38.3 ± 14.6 years were converted to SRL. The main reasons for conversion were elective in 45 (70.3%) and biopsy-proven chronic allograft nephropathy in 11 (17.2%). The primary CNI used was cyclosporine A in 51 patients. Mean time to conversion was 50.5 months. After conversion, 61 patients received mycophenolate mofetil. We evaluated the impact of conversion on renal function for 5 years post-conversion. The overall mean follow-up time was 72.8 months.

Results

The analysis showed significant improvement in renal function at month 3 post-conversion (P < 0.05) with stabilization thereafter. Lipid parameters and blood sugar levels were similar pre- and post-conversion. Abnormal liver function test was transient in 12.8%. Reasons for SRL discontinuation were nephrotic range proteinuria in two patients and mouth ulceration in one. We compared patients with serum creatinine <140 μmol/l and those with serum creatinine ≥140 μmol/l, and found that serum creatinine was an independent risk factor for chronic allograft dysfunction (P = 0.02). Graft loss occurred in three patients because of cardiovascular death in two and an acute rejection episode in one.

Conclusions

We concluded that conversion from CNIs to SRL is an option and of benefit without significant acute rejection episodes or chronic allograft dysfunction especially in well-selected kidney transplant recipients with good graft function.
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Metadata
Title
Sirolimus-based calcineurin inhibitor withdrawal immunosuppressive regimen in kidney transplantation: a single center experience
Authors
Sameer M. Alarrayed
Amgad E. El-Agroudy
Ahmad S. Alarrayed
Sumaya M. Al Ghareeb
Taysir S. Garadah
Salah Y. El-Sharqawi
Ali H. Al-Aradi
Balaji G. Dandi
Sadiq Abdulla
Publication date
01-06-2010
Publisher
Springer Japan
Published in
Clinical and Experimental Nephrology / Issue 3/2010
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-010-0269-0

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